Intrauterine contraceptive device

ABSTRACT

A method for promoting contraception by placing a contraceptive device within a uterus without blocking fallopian tubes may involve advancing a distal end of a delivery device through a cervix, advancing the contraceptive device comprising an elongate shape memory member out of the distal end of the delivery device and into the uterus, and limiting inferior migration of the contraceptive device within the uterus. Inferior migration may be limited by allowing the contraceptive device to assume a shape, when subjected to pressure that tends to cause a downward migration of the device within the uterus, in which an expandable middle portion of the device is expanded to contact the inner wall of the uterus and thus limit the downward migration of the device.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/796,965, now U.S. Pat. No. 9,427,351, filed Jul. 10, 2015, entitled“INTRAUTERINE CONTRACEPTIVE DEVICE,” which is a continuation of U.S.patent application Ser. No. 13/795,940, now U.S. Pat. No. 9,089,418,filed Mar. 12, 2013, entitled “INTRAUTERINE CONTRACEPTIVE DEVICE,” whichis a continuation-in-part of U.S. patent application Ser. No.13/585,039, now U.S. Pat. No. 9,265,652, filed Aug. 14, 2012, entitled“INTRAUTERINE CONTRACEPTIVE DEVICE.” The disclosures of all theabove-referenced patent applications are hereby incorporated byreference in their entireties herein.

FIELD

The invention relates generally to medical devices. More specifically,the invention relates to an intrauterine device for contraception andmethod for use.

BACKGROUND

Intrauterine devices (IUDs) are a commonly used form of contraception.There are two basic types of currently available IUDs—copper-releasingand progesterone-releasing. The copper IUD is a T-shaped device made ofpolyethylene wrapped with copper wire. The device acts as a foreign bodywithin the uterus and releases copper to produce a chemical effect onthe endometrium of the uterus and to alter the production of cervicalmucus, thus producing a spermicidal environment.

Progesterone-releasing IUDs are also T-shaped devices and include acylindrical reservoir containing levonorgestrel, which is released intothe uterus over time. The levonorgestrel adds to the foreign bodyeffects to create added spermicidal action and also thickens cervicalmucus to act as a barrier to sperm penetration into the uterus.

Although both copper and progestin-releasing IUDs work well forcontraception, both have common side effects. The most common sideeffects with copper IUDs are abnormal bleeding and pain. The most commonside effects with levonorgestrel IUDs are hormone-related effects, suchas headaches, nausea, breast tenderness, depression and cyst formation.When either copper or hormone/levonorgestrel is used as an activeingredient, it is typically thought that the larger the surface area ofcopper or hormone exposed in the uterus, the better the contraceptiveaction of the IUD. Although a larger surface area of exposed copper orhormone creates a higher risk of abnormal bleeding or other sideeffects, it is thought to be necessary to achieve effective birthcontrol. Thus, for example, currently available copper IUDs typicallyhave an exposed copper surface area of 380 mm squared. Past scientificstudies of similarly configured IUDs, but with a reduced copper surfacearea of 200 mm squared, showed higher failure rates (undesirablepregnancies) in the range of 3%-10%.

In addition to the above shortcomings, many currently available IUDs areat least slightly uncomfortable and/or challenging to deliver into theuterus. All IUDs are delivered through the cervix using a deliverysheath. Although this delivery method works well in many cases, therequired size of the currently available IUDs typically requires asheath having an outer diameter that can cause pain or discomfort uponinsertion into a cervix. In some cases, the pain can even besignificant. Thus, the size of currently available IUDs and theirdelivery sheaths is another shortcoming.

Therefore, although existing IUDs work relatively well for their purposeof contraception, there is still a need for improved IUDs. Ideally, suchimproved IUDs would provide reliable, long-acting contraception withrelatively few, minor side effects. At least some of these objectivesare met by the embodiments described in this application.

BRIEF SUMMARY

Based on the various drawbacks of currently available IUDs, variousembodiments of IUDs described herein provide contraception without theuse of copper, levonorgestrel, other hormones or other substances. TheseIUDs provide contraception by providing an effective foreign bodyresponse within the uterus and in some cases by applying pressureagainst the uterine wall. The IUDs described herein are generally madeat least in part of shape memory material, such as but not limited toNitinol.

In other embodiments described herein, an IUD may deliver copper and/oranother spermicide in a targeted fashion to one or more targeted areaswithin the uterus. For example, in one embodiment, copper may be focallydelivered by at IUD at or near openings of the fallopian tubes and at ornear the cervical os. By delivering a substance more selectively (or“focally”), these IUD embodiments provide effective contraception withsmaller doses of copper (or other substance) than currently availableIUDs. Generally, the limited, focal delivery of a substance such ascopper is augmented by the IUD acting as a foreign body within theuterus, thus providing effective contraception.

In one aspect, a method for promoting contraception by placing acontraceptive device within a uterus without blocking fallopian tubesmay include advancing a distal end of a delivery device through acervix, advancing the contraceptive device comprising an elongate shapememory member out of the distal end of the delivery device and into theuterus, and limiting inferior migration of the contraceptive devicewithin the uterus. Advancing the contraceptive device out of the distalend of the delivery device may cause the device to expand from a first,compressed shape within the delivery device to a second, expanded shapewithin the uterus. In the expanded shape, two tissue contact surfaces atopposite ends of the shape memory member may contact the inner wall ofthe uterus, and each of the tissue contact members, when thecontraceptive device is delivered, may be positioned near, but notwithin, an opening of one of the two fallopian tubes branching from theuterus. Inferior migration may be limited by allowing the contraceptivedevice to assume a third shape, when subjected to pressure that tends tocause a downward migration of the device within the uterus, in which thetissue contact members are closer together than in the second shape andin which an expandable middle portion of the device is expanded tocontact the inner wall of the uterus and thus limit the downwardmigration of the device.

In some embodiments, each of the tissue contact surfaces, when thedevice is delivered, may be positioned within approximately 2 cm of anopening of one of the fallopian tubes. Optionally, some embodiments ofthe method further involve delivering a substance within the uterus viathe contraceptive device, where the substance may include but is notlimited to one or more hormones, spermicides, copper and/or therapeuticagents. In one embodiment, delivering the substance may involvedelivering copper to at least one selected area of the uterus in a moreconcentrated dose than to at least one other area of the uterus via atleast one substance delivery member disposed on the contraceptive devicein at least one location configured to provide the substance at the atleast one selected area. In some of such embodiments, a total exposedsurface area of the substance delivery member(s) may equal no more thanabout 200 square millimeters. In some embodiments, the substancedelivery member(s) may include at least two substance delivery members,and each of the at least two substance delivery members may bepositioned on the contraceptive device so that it will be located at ornear an ostium of one of the fallopian tubes when the contraceptivedevice is delivered to the uterus. Optionally, the substance deliverymember(s) may further include at least one additional substance deliverymember positioned on the contraceptive device so that it will be locatedat or near an internal cervical os when the contraceptive device isdelivered to the uterus.

In some embodiments, the method may further include removing thecontraceptive device through the cervix by pulling on a thread connectedto the contraceptive device. In some embodiments, the distal end of thedelivery device may be tapered, and the contraceptive device may becompletely contained within the delivery device during advancement ofthe delivery device through the cervix. In some embodiments, advancingthe contraceptive device out of the delivery device may involvedelivering the contraceptive device to a first, inferior location in theuterus, and the method may further include allowing the contraceptivedevice to migrate superiorly to a second location in the uterus afterdelivery. In some embodiments, the method may further involve applyingsufficient pressure against the wall of the uterus with the tissuecontact surfaces to promote contraception.

In another aspect, a method for promoting contraception may involvedelivering a substance to one or more targeted areas in a uterus in amore concentrated dose than to at least one other area in the uterus viaa contraceptive device having at least one substance delivery memberlocated thereon. In such a method, a total exposed substance deliverysurface area of the substance delivery member(s) may equal no more thanabout 200 square millimeters.

In some embodiments, the method may also involve, before delivering thesubstance, advancing a distal end of a delivery device through a cervix,and advancing the contraceptive device comprising an elongate shapememory member out of the distal end of the delivery device and into theuterus, thus causing the contraceptive device to expand from a first,compressed shape within the delivery device to a second, expanded shapewithin the uterus, where two tissue contact surfaces at opposite ends ofthe shape memory member contact the inner wall of the uterus when thecontraceptive device is in the second shape, and where each of thetissue contact members, when the contraceptive device is delivered, ispositioned near, but not within, an opening of one of the two fallopiantubes branching from the uterus.

In some embodiments, the substance is copper, and the substance deliverymember(s) include at least a first substance delivery member positionedon the elongate member at or near a first one of the tissue contactsurfaces, a second substance delivery member positioned on the elongatemember at or near a second one of the tissue contact surfaces, and athird substance delivery member positioned on the elongate member at ornear a middle portion configured to be located at or near a cervical oswhen the contraceptive device is located within the uterus. In someembodiments, the method may further include limiting inferior migrationof the contraceptive device within the uterus by allowing thecontraceptive device to assume a third shape when subjected to pressurethat tends to cause a downward migration of the device within theuterus, in which the tissue contact members are closer together than inthe second shape and in which an expandable middle portion of the deviceis expanded to contact the inner wall of the uterus and thus limit thedownward migration of the device. In some embodiments, the method mayfurther include applying sufficient pressure against the wall of theuterus with the tissue contact surfaces to promote contraception.

In some embodiments, the substance is copper, and the substance deliverymember(s) include at least three substance delivery members, two ofwhich are positioned on the contraceptive device so that they will belocated at or near an ostium of a fallopian tube and one of which ispositioned on the contraceptive device so that it will be located at ornear a cervical os when the contraceptive device is delivered to theuterus. In alternative embodiments, the substance may be one of anynumber of spermicidal agents other than copper. In some embodiments, themethod may further include delivering an additional substance to theuterus, where the additional substance may include but is not limited toLevonorgestrel, other hormones and/or therapeutic agents. In variousembodiment, the total exposed surface area of the substance deliverymembers may equal no more than about 200 square millimeters.

In another aspect, a method for promoting contraception by focallydelivering a substance within a uterus may first involve advancing acontraceptive device out of a distal end of a delivery device and intothe uterus, thus causing the contraceptive device to expand from afirst, compressed shape within the delivery device to a second, expandedshape within the uterus, where two tissue contact surfaces at oppositeends of the contraceptive device contact an inner wall of the uteruswhen the contraceptive device is in the second shape, and where each ofthe tissue contact surfaces, when the contraceptive device is delivered,is positioned near, but not within, one of two fallopian tube openings.Next, the method may involve delivering the substance to at least onetargeted area of the uterus over time, via the contraceptive device,where the at least one targeted area includes areas at or near both ofthe fallopian tube openings, and where the contraceptive device includesat least one substance delivery member located at or near each of thetissue contact surfaces to deliver the substance at or near thefallopian tube openings. Finally, the method may also involve allowingthe contraceptive device to partially collapse within the uterus suchthat the at least one substance delivery member forms a continuous lineacross the uterus from one side to an opposite side of the inner wall ofthe uterus.

In some embodiments, the contraceptive device may include at least threesubstance delivery members, and advancing the contraceptive device maycause at least one of the substance delivery members to be positioned ator near each of the openings of the fallopian tubes and one of thesubstance delivery members to be positioned at or near a cervical os. Insome embodiments, delivering the substance comprises delivering copper,and a total exposed surface area of the substance delivery members is nomore than about 200 square millimeters. In some embodiments, thecontraceptive device may include an elongate shape memory member, thesubstance delivery member(s) may be formed as sleeves disposed aroundthe shape memory member, and allowing the contraceptive device topartially collapse causes the substance delivery members to movetogether to form an approximately continuous cylinder.

In another aspect, a method for approximating contractility of a uterusmay first involve advancing a contraceptive device comprising a shapememory member out of the distal end of a delivery device and into theuterus, thus causing the contraceptive device to expand from a first,compressed shape within the delivery device to a second, expanded shapewithin the uterus, where two tissue contact surfaces at opposite ends ofthe contraceptive device contact the inner wall of the uterus when thecontraceptive device is in the second, expanded shape, and where each ofthe tissue contact surfaces, when the contraceptive device is delivered,is positioned near, but not within, an opening of a fallopian tube. Themethod may then involve visualizing, using a visualization device, thecontraceptive device in the second shape in which a middle portion ofthe device is expanded. The method may then involve approximatingcontractility of the uterus by comparing an amount of expansion of themiddle portion of the device with a known amount of expansion of themiddle portion when the device is completely unconstrained. In someembodiments, visualizing the contraceptive device may involve using aradiographic visualization device positioned outside the uterus and atleast a portion of the middle portion of the contraceptive device may beradiopaque.

In another aspect, a shape memory, intrauterine, contraceptive devicemay include two tissue contact surfaces at or near opposing ends of thedevice, an expandable middle portion between the tissue contactsurfaces, and a spring portion at or near a midpoint of the elongatemember. The contraceptive device may be configured to move from a first,default configuration when unconstrained to a second, partiallycollapsed configuration when the two tissue contact surfaces are forcedtoward one another by an inner wall of a uterus. The expandable middleportion is expanded in the second shape such that it contacts the innerwall of the uterus to help prevent migration of the contraceptive deviceout of the uterus.

In some embodiments, the two tissue contact surfaces, the middle portionand the spring portion comprise one shape memory wire. In someembodiments, the spring portion, the middle portion, and two armsextending from the middle portion comprise a shape memory wire, and thedevice further includes two tissue contact members, each of which iscoupled with one of the opposing ends of the shape memory wire to formthe tissue contact surfaces. In some embodiments, the contraceptivedevice may include a shape memory wire made of a material such as butnot limited to Nitiniol, other shape memory metal alloys and/or shapememory polymers. In one embodiment, the shape memory wire may have adiameter of between about 0.015 inch and about 0.017 inch. In oneembodiment, the middle portion may be expandable, in the second shape,to a width approximately equal to a distance between the two tissuecontact surfaces. In one embodiment, the device may be compressible intoa third, fully collapsed configuration for positioning within a deliverysheath having an inner diameter of between about 2.70 mm and about 2.90mm.

Some embodiments may further include a substance coupled with the devicefor delivery to the uterus, such as but not limited to one or morehormones, spermicides, copper, zinc and/or therapeutic agents. In someembodiments, the substance may be coupled with the device via at leastone substance delivery member attached to the device. In someembodiments, the substance may be copper, and a total exposed surfacearea of the substance delivery member(s) is no more than approximately200 square millimeters. In some embodiments, the contraceptive devicemay include a shape memory wire, and the substance delivery member(s)may include a first copper sleeve disposed over the shape memory wire ator near a first one of the tissue contact surfaces, a second coppersleeve disposed over the shape memory wire at or near a second one ofthe tissue contact surfaces, and a third copper sleeve disposed over theshape memory wire at or near the spring portion.

In some embodiments, a contraceptive device for focally delivering asubstance in a uterus may include an elongate shape memory member havingtwo opposing ends and a spring portion between the opposing ends and atleast one substance delivery member disposed along a minority of alength of the shape memory member at a location to locally deliver thesubstance, when the contraceptive device is placed in the uterus, to atleast one of an area near a fallopian tube or an area near a cervicalos.

In some embodiments, the substance delivery member(s) may include twosubstance delivery sleeves, where each of the sleeves is disposed overthe shape memory member at or near one of the opposing ends. In someembodiments, the substance delivery member(s) may include a substancedelivery sleeve disposed over the shape memory member at or near thespring portion. In some embodiments, the substance delivery member(s)may include at least one substance delivery sleeve disposed over theshape memory member at or near each of the opposing ends and at leastone substance delivery sleeve disposed over the shape memory member ator near the spring portion. In some embodiments, the substance mayinclude copper or any of a number of other spermicidal agents. In oneembodiment, the substance is copper, and the substance delivery membershave a total surface area no more than about 200 square millimeters.Optionally, the device may further include a hormone delivery memberdisposed at a different location along the shape memory member from alocation of the substance delivery member.

In another aspect, an intrauterine device for promoting contraceptionwithout blocking the fallopian tubes may include an elongate shapememory member having two opposing ends, a spring portion atapproximately a midpoint between the two ends, a default configurationwhen released from constraint, and a collapsed configuration whenconstrained. The device may further include least one copper deliverymember coupled with the shape memory member at or near each of the twoends for focally delivering a substance to a uterus in an area at ornear openings of the fallopian tubes, where a total exposed surface areaof the substance delivery members is no more than 200 squaremillimeters.

In some embodiments, the shape memory member may further include anexpandable middle portion that expands when the two opposing ends areforced toward one another by an inner wall of the uterus, wherein theexpanded middle portion may contact the wall of the uterus to helpprevent migration of the device out of the uterus. In some embodiments,the substance delivery members, when pushed together by the inner wallof the uterus pushing together the opposing ends, form an approximatelycontinuous line across the uterus. In some embodiments, the elongatemember is made of a shape memory material, such as but not limited toNitinol, other shape memory metal alloys and/or shape memory polymers.

In some embodiments, the two opposing ends may be looped portions of theelongate member, and the elongate member may be made of Nitinol. In someembodiments, the spring portion may be a spring having at least one coilformed in the elongate member. In some embodiments, the device in thecollapsed configuration may be sufficiently small to fit within adelivery sheath having an inner diameter of between about 2.70 mm andabout 2.90 mm. In some embodiments, the elongate member may have adiameter of between about 0.015 inch and about 0.017 inch. In someembodiments, the substance delivery member(s) may include multiplesubstance delivery sleeves disposed over the shape memory member. Insome embodiments, the sleeves may include at least one sleeve at or nearone of the ends, one sleeve at or near an opposite end, and one sleeveat or near the spring portion.

In another aspect, a contraceptive device that may also be used forapproximating contractility of a uterus may include an elongate shapememory member having two opposing ends, a spring portion at a midpointof the elongate member, a default expanded configuration, and acollapsed configuration. The device may also include two tissue contactsurfaces, each of which is disposed at one of the opposing ends of theelongate member and a middle portion of the elongate member that expandsin direct proportion to compression pressures acting upon the two tissuecontact surfaces such that a separation distance of the middle portionof the elongate member may be used to approximate contractility of theuterus. Optionally, the device may also include at least one radiopaquemarker or material on the middle portion of the elongate member tofacilitate visualization of the middle portion using a radiographicvisualization device.

In another aspect, a contraceptive system may include a shape memory,intrauterine, contraceptive device and a delivery device for housing anddelivering the contraceptive device into the uterus through a cervix.The contraceptive device may include two tissue contact surfaces at ornear opposing ends of the device and an expandable middle portionbetween the tissue contact surfaces. The contraceptive device may beconfigured to move from a first, default configuration whenunconstrained to a second, partially collapsed configuration when thetwo tissue contact surfaces are forced toward one another by an innerwall of a uterus, where the expandable middle portion is expanded in thesecond shape such that it contacts the inner wall of the uterus to helpprevent migration of the contraceptive device out of the uterus. Thedelivery device may include a shaft having a tapered distal tip and apusher member disposed inside the shaft for at least one of advancingthe contraceptive device out of the distal tip or maintaining a positionof the contraceptive device within the shaft while the shaft isretracted.

In some embodiments, the contraceptive device may be preloaded into theshaft of the delivery device before providing the system to a customer.For example, in some embodiments, the contraceptive device may bepreloaded through a proximal end of the shaft of the delivery device. Insome embodiments, the shaft of the delivery device may have an innerdiameter of no more than about 3.00 mm and an outer diameter of no morethan about 3.40 mm. In some embodiments, the contraceptive device mayinclude a Nitinol wire. In some embodiments, the shaft of the deliverydevice may include an inner surface having at least one slot fordirecting advancement of the contraceptive device out of the distal tip.Optionally, the contraceptive device may further include at least onesubstance delivery member for delivering a substance within the uterus.In some embodiments, the substance is copper, the substance deliverymember(s) include at least one substance delivery member at or near eachof the tissue contact surfaces, and a total exposed surface area of thesubstance delivery member(s) is no more than about 200 squaremillimeters.

In another aspect, A contraceptive device for focally delivery asubstance in a uterus comprises an elongate shape memory member havingtwo opposing ends located at each end of a pair of arms, a portionbetween the opposing ends comprising a portion of the pair of arms thatcross each other in a series of twists, wherein the arms exit the seriesof twists to form the opposing ends, and at least one substance deliverymember disposed along a portion of the elongate shape memory member at alocation to locally deliver the substance, when the contraceptive deviceis placed in the uterus, to at least one of an area near a fallopiantube or an area near a cervical os, or both. The length, placement, ornumber of turns of the series of twists may at least in part define thedevice stiffness.

These and other aspects and embodiments of the invention are describedin greater detail below, with reference to the drawing figures.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a front view of an intrauterine device (IUD), according to oneembodiment;

FIGS. 2A-2F show a cross-sectional view of a uterus, cervix andfallopian tubes, illustrating a method for delivering an intrauterinedevice (IUD) into a uterus, according to one embodiment;

FIG. 3 is a front view of an IUD, according to an alternativeembodiment;

FIGS. 4A and 4B illustrate a method for using the IUD of FIG. 3,according to one embodiment;

FIG. 5 is a front view of an IUD including copper sleeves for focalcopper delivery, according to one embodiment;

FIGS. 6A and 6B are front and perspective views, respectively, of an IUDincluding copper sleeves for focal copper delivery, according to analternative embodiment;

FIGS. 7A and 7B are cross-sectional views of a uterus, showing aninsertion location and a migrated location of an IUD such as that shownin FIGS. 6A and 6B, according to one embodiment;

FIGS. 8A and 8B are cross-sectional views of a uterus, showing expandedand partially contracted views of an IUD including copper sleeves forfocal copper delivery, according to one embodiment;

FIGS. 9A-9D are front, bottom, side and perspective views, respectively,of an IUD including copper sleeves for focal copper delivery, accordingto another alternative embodiment;

FIG. 10 is a front view of an IUD including a twisted middle portion andcopper sleeves for focal copper delivery, according to one embodiment;and

FIG. 11 is a perspective view of an IUD delivery device, according toone embodiment.

DETAILED DESCRIPTION

Referring to FIG. 1, in one embodiment, a contraceptive intrauterinedevice (IUD) 1010 may include a shape memory, elongate member 1012 andtwo tissue contact members 1016, 1018 disposed at opposite ends ofelongate member 1012. Elongate member 1012 may include a spring portion1014, typically but not necessarily disposed approximately at a midpointbetween the opposite ends of elongate member 1012, an expandable middleportion 1020, two arms 1015 extending from middle portion 1020, andbends 1022 between middle portion 1020 and arms 1015. All or a part ofeach tissue contact member 1016, 1018 may comprise a tissue contactsurface, in other words, a surface that typically contacts an inner wallof a uterus when IUD 1010 is deployed in the uterus.

Elongate member 1012 is manufactured from a resilient, shape memorymaterial, such as but not limited to Nitinol (nickel titanium alloy),spring stainless steel, other shape memory metal alloys, shape memorypolymers, or the like, and has a default (or “predetermined”) expandedconfiguration as shown in FIG. 1. Elongate member 1012 may be compressedinto a low profile, collapsed configuration, to facilitate preloading ofIUD 1010 into a delivery sheath and delivery of IUD 1010 through acervix via the sheath. When released from compression within the uterus,IUD 1010 springs back into its default expanded configuration to allowtissue contact members 1016, 1018 to contact the uterine wall and, bythe force inherent in its shape memory material, apply sufficientpressure against the inner wall of the uterus to maintain IUD 1010 inposition within the uterus. In many cases, IUD 1010 may not spring backinto its fully expanded, default configuration when delivered into theuterus, due to force applied upon it by the uterine wall. Thus, it ispossible to discuss an “expanded configuration” of IUD 1010 withoutnecessarily meaning that it is fully expanded to it defaultconfiguration.

In some embodiments, IUD 1010 may be configured to assume a partiallycollapsed configuration, in which the uterine wall has pushed the twotissue contact members 1016, 1018 together to cause middle portion 1020to expand laterally. This partially collapsed configuration is describedin further detail below. Generally, this configuration may occur whenforces applied by the uterine wall cause IUD 1010 to migrate slightly inan inferior direction (i.e., toward the cervical os). As middle portion1020 expands, it may help prevent further inferior migration bycontacting the inner uterine wall and thus acting as a stop mechanism.

In its fully expanded configuration, such as in FIG. 1, (or whenpartially expanded) IUD 1010 in some embodiments applies outwardlydirected pressure against the uterine wall that is sufficient only tohelp maintain IUD 1010 in a desired location in the uterus and preventor at least limit inferior migration. In these embodiments, IUD 1010provides contraceptive effect primarily or exclusively by acting as aforeign body in the uterus. In alternative embodiments, IUD 1010 mayapply a greater amount of pressure against the uterine wall, such thatthe applied pressure helps facilitate or enhance the contraceptiveeffect. Various embodiments of IUD 1010 described herein may thus be“pressure-applying” or “non-pressure-applying,” but in either case theywill be configured to provide effective contraception. Thus, anyparticular embodiment described herein should not be interpreted tolimit the claims to a particular amount of pressure applied to a uterus,unless such limitation is specifically set forth in a claim.

As illustrated in FIG. 1, in one embodiment, spring portion 1014 isdisposed at the vertex (or bottom) of elongate member 1012, middleportion 1020 extends upward from spring portion 1014 in approximately anelongate oval shape, elongate member 1012 crosses over itself and formsbends 1022, and then it extends into arms 1015. Although thisconfiguration is described in reference to this embodiment, IUD 1010 mayhave any of a number of different expanded configurations in alternativeembodiments. Furthermore, although the term “spring portion” is used todescribe a portion of elongate member 1012 that helps confer laterallydirected pressure to tissue contact members 1016, 1018, spring portion1014 is not necessarily a spring. In many of the embodiments, forexample, spring portion 1014 is simply a midpoint of elongate member1012 that is formed as a loop. In other embodiments, spring portion 1014may have any of a number of different shapes.

IUD 1010 may be said to have a wingspan (or “width”) W, as measured froma tip of one tissue contact member 1016 to a tip of the other tissuecontact member 1018. IUD 1010 may also be said to have a height (or“length”) H, as measured from the bottom of spring portion 1014 to thetops of tissue contact members 1016, 1018. Wingspan W and height H aregenerally selected to provide IUD 1010 with a desired amount oflaterally directed pressure at tissue contact members 1016, 1018, sothat IUD 1010 will maintain itself in a given location within the uterusand exert sufficient pressure to promote contraception. In oneembodiment, for example, IUD 1010 may have a height H of between about25 mm and about 28 mm and a wingspan W of between about 44 mm and about46 mm. Alternative sizes may be provided to enhance the effectiveness ofIUD 1010 in different female anatomies, but because IUD 1010 issufficiently resilient and the uterus is typically a closed space, IUD1010 is generally a “one size fits all” device.

As just mentioned, the uterus (or “uterine cavity”) is generally not anopen space. Even though the uterus is typically illustrated as an openspace, such as in FIGS. 2A-2F, this is simply a schematic illustration,because the uterus itself is a closed space. IUD 1010 should, therefore,have sufficient laterally directed pressure when released from adelivery device within the uterus to expand within the closed uterinecavity. The uterus is also typically a moist environment, so IUD 1010should have sufficient resiliency to overcome any surface tension thatmight hold the opposed surfaces of the inner wall of the uterustogether. In embodiments in which substances (copper, hormone, etc.) arenot included, it is also important that IUD 1010 apply sufficientlaterally directed pressure to promote contraception. It is believedthat pressure applied to the inner uterine wall by tissue contactmembers 1016, 1018 may by itself disrupt the uterine environment in sucha way to cause a spermicidal effect, thus preventing conception. Thepressure exerted against the uterine wall by IUD 1010 may cause aninflammatory response, ischemia, compression of the spiral artery and/ora combination thereof, and any or all of these may help promotecontraception.

Finally, IUD 1010 should have sufficient laterally directed pressure toprevent inferior migration of the device within the uterus or expulsionof the device from the uterus. As is described in greater detail below,IUD 1010 likely has the greatest contraceptive effect when it resides ina certain portion of the uterus, so ideally IUD 1010 will havesufficient outwardly directed pressure to prevent inferior migration orexpulsion of the device. In some embodiments, IUD 1010 also has aconfiguration and applies sufficient force to promote superior migrationof the device after delivery, which At the same time, another objectiveof IUD 1010 is to prevent perforation of the uterine wall, so IUD 1010should not have an excessive amount of outwardly directed pressure.

IUD 1010 generates laterally directed, expansile pressure due to thenature of its resilient, shape memory material (typically but notnecessarily Nitinol), the diameter of its material, and its default,expanded shape and size, including spring portion 1014. Spring portion1014 may in some embodiments be an actual spring or looped portion ofelongate member 1012, while in alternative embodiments it may be any ofa number of other suitable shapes that help confer laterally directedpressure to elongate member 1012. This laterally directed pressurepushes tissue contact members 1016, 1018 against the uterine wall withsufficient pressure that they first move along the wall to a desiredlocation for promoting contraception and then maintain their position on(or “adhere to”) the wall at that location. IUD 1010 may also have ashape, size, lateral pressure, and size and shape of tissue contactmembers 1016, 1018 that help prevent tissue contact members 1016, 1018from advancing (or “migrating”) into the fallopian tubes. It may beadvantageous for IUD 1010 to avoid entering the fallopian tubes, becausethis may facilitate removal of IUD 1010 when desired. Delivery,adherence to the uterine wall and other characteristics of IUD 1010 aredescribed in further detail below. By generating adhering pressureagainst the uterine wall, IUD 1010 remains in the uterus as a foreignbody and provides further contraceptive effect by the application ofpressure, thus safely preventing unwanted pregnancy.

As mentioned, in one embodiment, elongate member 1012 is made ofNitinol. In various embodiments, the diameter of elongate member 1012may be selected to help provide a desired amount of lateral pressuregeneration when the device is in the default expanded configuration ofFIG. 1. For example, in some embodiments, elongate member 1012 may be aNitinol wire with a diameter of between about 0.010″ and about 0.025″and more ideally between about 0.014″ and about 0.015″.

In alternative embodiments, resilient materials other than Nitinol maybe used, such as other shape memory metal alloys, spring stainless steelor the like. Nitinol is typically preferred, however, due to its abilityto remain in a compressed configuration (such as in a delivery catheter)for long periods of time, fully spring back into its expandedconfiguration, and maintain a constant but gentle pressure against theuterine wall for many years of useful life of IUD 1010. The materialproperties of a Nitinol IUD 1010 allow it to be compressed into acollapsed or low profile configuration for storage in a delivery device,stored in that configuration for long periods of time, and thendelivered out of the delivery device to assume its default, expandedconfiguration. Other resilient materials typically do not retain theirfull resilient properties over time in this way, although to the extentother materials would serve this purpose they may be used in alternativeembodiments. Storing and/or packaging IUD 1010 within a delivery devicemakes its use easier, because the end user (typically a physician orphysician's assistant) is not required to load the device into thedelivery device. By contrast, currently available IUDs typically must beloaded into their delivery devices by a physician or physician'sassistant before use. IUD 1010 formed of Nitinol is also unique in thatit provides a constant lateral pressure in various uterine sizes and isthus a “one size fits all” device. Constant gentle lateral pressurealong the inner uterine wall also prevents expulsion of IUD 1010 out ofthe uterus, which is one of the potential complications of currentlyavailable IUDs.

Tissue contact members 1016, 1018 may be comprised of any of a number ofsuitable materials and may have a number of different sizes and shapes.In some embodiments, IUD 1010 may include tissue contact members 1016,1018 made of different or the same material as elongate member 1012.Alternatively, an IUD may include “tissue contact surfaces” that arepart of elongate member 1012. These tissue contact surfaces may also bereferred to as “tissue contact points” or “end points.” Tissue contactmembers 1016, 1018 also generally include tissue contact surfaces (i.e.,a portion of each tissue contact member 1016, 1018 that contacts theuterine wall). Thus, the phrases “tissue contact members,” “tissuecontact surfaces,” “tissue contact points” and “end points” maysometimes be used herein interchangeably and should not be interpretedto limit the scope of the invention as set forth in the claims.

Generally, the material, size and shape of tissue contact members 1016,1018 are selected to prevent, or at least reduce the tendency for,tissue in-growth of tissue contact members 1016, 1018 into uterine walltissue while also preventing inferior migration or expulsion of IUD1010. Tissue in-growth prevention is important for facilitating laterremoval of IUD 1010 from the uterus if and when desired. This preventionof tissue in-growth is in direct contrast to a number of prior artpermanent contraception or sterilization devices that purposely try topromote tissue in-growth, for example to permanently attach a devicewithin the fallopian tubes. IUD 1010, in contrast, is usually easilyremoved and does not permanently adhere to the uterine wall. In oneembodiment, tissue contact members 1016, 1018 may be made of a highdensity polyethylene. In alternative embodiments, tissue contact members1016, 1018 may be made of any of a number of alternative, typicallynon-porous materials, such as but not limited to metals, plastics,elastomers such as silicone, or combinations thereof. Furthermore,tissue contact members 1016, 1018 may be coated, such as with a coatingto prevent tissue in-growth, or may be impregnated with variousmedications or other substances, such as but not limited to hormone,spermicide or the like. Tissue contact members 1016, 1018 may also bemade of (or coated with) an echogenic material to facilitatevisualization of IUD 1010 using transvaginal ultrasound or othervisualization techniques.

Tissue contact members 1016, 1018 may have any suitable size and shapebut are generally configured to apply a desired amount of pressure tothe uterine wall to maintain the position of IUD 1010, in someembodiments to promote contraception, and to prevent tissue in-growth,without causing pain or uterine wall perforation, a well known risk ofcurrently available intrauterine devices. Tissue contact members 1016,1018 must also be sized so that they can be effectively deliveredthrough a low profile delivery device without pain to the patient. Toachieve these goals, tissue contact members 1016, 1018 according to oneembodiment have a diameter of between about 1 mm and about 8 mm, andpreferably between about 2 mm and about 4 mm, and even more preferablybetween about 2.5 mm and about 3.5 mm. Tissue contact members 1016, 1018according to this embodiment may have a length of between about 3.0 mmand about 5.0 mm, and preferably between about 3.5 mm and about 3.6 mm.Also according to one embodiment, each tissue contact member 1016, 1018has a surface area of between about 30 mm squared and about 45 mmsquared, and preferably between about 31 mm squared and about 32 mmsquared. Providing tissue contact members 1016, 1018 with a relativelylarge surface area (while keeping them small enough to fit within adelivery device) may help prevent uterine wall perforation andin-growth, while still allowing for the application of a desired amountof laterally directed pressure against the uterine wall.

Referring now to FIGS. 2A-2F, a portion of the female reproductiveanatomy is shown in schematic form in cross-section, and a method fordelivering IUD 1010 to a uterus U is illustrated. As shown in FIG. 2A,the vagina V leads into the cervix C, which in turn leads into theuterus U (illustrated schematically as an open cavity). The uterus U hasan inner wall W, which in this application is referred to simply as theuterine wall. Two fallopian tubes F branch off of the uterus U. Duringthe natural reproductive cycle, eggs travel down the fallopian tubes Fto be fertilized by sperm (typically within a fallopian tube F), and thefertilized egg then implants on the uterine wall W to grow into a fetus.IUD 1010 works primarily or exclusively by producing a “hostileenvironment” in the uterus U for sperm and thus preventingfertilization, or secondarily, if fertilization occurs, by blockingimplantation.

With reference to FIG. 2B, as a first step in a method for IUD delivery,an IUD delivery device 1020 containing IUD 1010 (not visible in FIG. 2B)may be advanced through the cervix C into the uterus U. While housed indelivery device 1020, IUD 1010 is in a collapsed, low profileconfiguration to facilitate its passage through the cervix C. In someembodiments, such as the one pictured, IUD 1010 may be completelycontained within delivery device 1020 during advancement of deliverydevice 1020 through the cervix C. As will be described further below,IUD 1010 may be preloaded into a proximal end of delivery device 1020,due to its shape memory material. This proximal preloading allowsdelivery device 1020 to have a tapered distal tip 1021, whichfacilitates advancement of delivery device 1020 through the cervix Cwith little or no pain or discomfort. Proximal preloading of IUD 1010into delivery device 1020 also makes the process easier for a user,since currently available IUDs must be pulled into the distal end of adelivery device by the physician or physician's assistant prior to use.Delivery device 1020 may take any of a number of suitable forms,typically including an outer sheath and an inner pusher member. Oneembodiment of a delivery device is described is described in furtherdetail below with reference to FIG. 10.

FIGS. 2C and 2D show the next steps in an IUD delivery process,according to one embodiment. FIG. 2C illustrates IUD 1010 partiallyexpelled from delivery device 1020 into the uterus U. In FIG. 2D, IUD1010 has been completely expelled from delivery device 1020 but is stillin contact with a pusher member 1022 of delivery device 1020. At thispoint, tissue contact members 1016, 1018 are contacting the uterine wallW. In various embodiments, IUD 1010 may be expelled from delivery device1020 using any of a number of different techniques and mechanisms. Inone embodiment, for example, pusher member 1022 may be held in a stableposition, and a sheath on delivery device 1020 may be retracted toexpose IUD 1010. Alternatively, a sheath may be held in a stableposition and pusher member 1022 may be advanced to push IUD 1010 out ofthe distal end of delivery device 1020. In another embodiment, pushermember 1022 may be advanced while a sheath is retracted. In otheralternative embodiments, other suitable means for expelling IUD 1010from delivery device 1020 may be used.

Comparing the position of IUD 1010 in FIGS. 2C and 2D shows that IUD1010 may advance along the uterine wall W toward the fallopian tubes Fduring and/or after delivery to eventually seat (or “adhere”) in an areajust below (or “inferior to”) the fallopian tube openings.Alternatively, IUD 1010 may simply be delivered directly to the desiredlocation within the uterus U rather than delivering it to an initiallocation and having it ride along the uterine wall W before seating atits final location. The words “seat” and “adhere” do not mean that IUD1010 permanently attaches to the uterine wall. In fact, as previouslymentioned, tissue contact members 1016, 1018 and IUD 1010 are designedto prevent tissue in-growth and permanent attachment to the uterinewall. “Seating” and “adhering” are thus generally used to simply meanmaintaining a relative position along the uterine wall. Ideally, but notnecessarily, each tissue contact member 1016, 1018 will seat in an areaof the uterine wall W within approximately 2 cm inferior of a fallopiantube opening, and preferably within approximately 1 cm inferior of afallopian tube opening. This is believed to be an ideal area for IUD1010 to reside for contraception, although an exact location for IUD1010 within the uterus is not required.

Movement of IUD 1010 along the uterine wall and adherence of IUD 1010 ata given location are caused by a combination of the amount of outwardpressure produced inherently by IUD 1010, the size and shape of IUD1010, the size, shape and physical characteristics of tissue contactmembers 1016, 1018, and the size and shape of the uterus U. IUD 1010 isconfigured to have enough outwardly directed pressure and othercharacteristics to make IUD 1010 adhere to the uterine wall W, typicallynear the fallopian tube orifices, without actually entering thefallopian tubes F. The pressure applied to the uterine wall W by the IUD1010 is believed to be at least one reason that IUD 1010 preventspregnancy. The constant, gentle pressure applied to the uterine wall Wis believed to disrupt the natural uterine environment. In alternativeembodiments, described further below, an IUD may simply contact theuterine wall and not apply any significant amount of pressure to thewall. In these embodiments, in other words, the IUD contacts the uterinewall with sufficient force only to maintain positioning of the IUD, inwhich case the IUD will include some form of substance deliverymechanism (copper, hormone, etc.) to provide contraceptive effect.

In its fully expanded, default configuration, IUD 1010 may have awingspan or width W (described previously), of between about 18 mm andabout 54 mm, depending upon the anatomical characteristics of thepatient. The wingspan W of IUD 1010 may be selected at least in part dueto the distance between the uterine wall W just inferior to onefallopian tube F and the uterine wall W just inferior to the oppositefallopian tube F. For example, the average intra-ostial distance innulliparous women is 29.2 mm, and the average intra-ostial distance inparous women is 30.0 mm, so the IUD wingspan may in some embodiments bebased at least in part on these measurements. (“Assessment Of TheUterine Cavity And The Intraostial Distance UsingHysterosalpingography”, Fertility and Sterility, Volume 88, Supplement1, September 2007, Page 5202, J. G. Bromer, F. Sanguinetti, M. Tal, P.Patrizio. Obstetrics, Gynecology, and Reproductive Sciences, YaleUniversity School of Medicine, New Haven, Conn.; Department ofRadiology, Yale University School of Medicine, New Haven, Conn.)

As described previously, when expanded, one embodiment of IUD 1010applies laterally directed pressure against the uterine wall W viatissue contact members 1016, 1018 to cause irritation/inflammation,ischemia, compression of arterial structures, and/or other effects thatpromote contraception. Additionally, IUD 1010 may apply sufficientpressure to slightly distort the shape of the uterine wall W, which isbelieved to further promote contraception. The amount of laterallydirected pressure applied to the uterine wall W is important for properfunctioning of IUD 1010, both for adherence (and thus migration andexpulsion prevention), and also for the added effect of uterine walldistortion. In various embodiments, a range of the pressure applied bytissue contact members 1016, 1018 to the uterine wall is between about0.002 pounds-pressure and about 0.025 pounds-pressure, and ideallybetween about 0.002 pounds-pressure and about 0.015 pounds-pressure.

Referring to FIG. 2E, IUD 1010 is shown in place in the uterus U,completely disconnected from delivery device 1020. At this point,delivery device 1020 may be removed through the cervix C, leaving IUD1010 in place, as shown in FIG. 2F. IUD 1010 then remains in the uterusU for as long as desired to promote contraception.

IUD 1010 may be left in the uterus U permanently or may be removed atany time. Because IUD 1010 is easily delivered and removed, it allowsfor nonsurgical contraception as an office procedure and without theneed for surgery or the necessity for visualization eitherradiologically, ultrasonically, or with a hysteroscope. IUD 1010 usesradial pressure and inherent properties in its construction to promotecontraception, thus eliminating the need for hormones or copper in thedevice. IUD 1010 also uses radial pressure prevent inferior migration orexpulsion. As such, IUD 1010 may be used for permanent or temporarycontraception. As described further below, although IUD 1010 does notrequire the use of hormones, copper or other substances, in alternativeembodiments it may also be adapted for local delivery of these or othertherapeutic agents. In other alternative embodiments, IUD 1020 may beconfigured to provide contraceptive effect primarily or exclusively viadelivery of a substance (copper, hormone, etc.) and not via applicationof pressure. IUD 1010 may also be used, in some embodiments, fortreatment of one or more conditions such as abnormal uterine bleedingand/or pelvic pain, in addition to providing contraception.

Referring now to FIG. 3, in another embodiment, a contraceptive device(or “IUD”) 2100 may have a similar configuration to that describedabove, but may have an elongate shape memory member 2102 formed intoloops at opposite ends to provide tissue contact surfaces (or “endpoints”) 2108 a, 2108 b, rather than having tissue contact membersattached to elongate member 2102. In all other aspects, the embodimentof IUD 2100 in FIG. 3 is the same as the embodiment of IUD 1010 inFIG. 1. As with the previously described embodiment, contraceptivedevice 2100 may include elongate member 2102, an expandable middleportion 2104, a spring portion 2106, two bends 2110 and two arms 2112.In various embodiments, elongate member 2102 may have a predominantlyflat (or “two-dimensional”) configuration, as shown. Alternatively,elongate member 2102 may have a more three-dimensional configuration(not shown). For example, one or more portions of elongate member 2102may be curved or bent, which in some embodiments may help elongatemember 2102 conform to a curved shape of a uterus.

Contraceptive device 2100 is shown, in FIG. 3, in its fully expanded,unconstrained, default configuration. Contraceptive device 2100 may alsobe compressed into a long, thin configuration for placement within adelivery device (not shown), such as a delivery catheter or sheath, bypulling/pushing tissue contact surfaces 2108 a, 2108 b upward, away fromspring portion 2106. The delivery device may be sufficiently small sothat it can be passed through a cervix without causing pain ordiscomfort and without requiring mechanical dilation, anesthesia(topical, local or general) or expansion of the cervix, cervical canalor internal or external cervical os. In some embodiments, for example,contraceptive device 2100 may be compressible/collapsible to a diameterthat fits within a delivery sheath having an inner diameter of betweenabout 2.50 mm and about 3.00 mm and more preferably between about 2.70mm and about 2.90 mm, and an outer diameter of between about 2.80 mm andabout 3.40 mm and more preferably between about 2.95 mm and about 3.20mm.

When contraceptive device 2100 is released from its delivery catheterinto the uterus, it expands to a configuration approximately like theconfiguration shown in FIG. 3. Typically, tissue contact surfaces 2108a, 2108 b will help device 2100 adhere to uterine wall tissue to remainin place near but not in the fallopian tubes. However, if contraceptivedevice 2100 begins to migrate down (or out of) the uterus, the uterinewall will pressure tissue contact members 2108 a, 2108 b together, thuspushing out the sides of middle portion 2104. The expanded sides ofmiddle portion 2104 will then provide increased mechanical resistance,including but not limited to, contacting the uterine wall and helping toprevent or resist migration. The expansion of middle portion 2104 isdirectly proportional to the amount of compression placed on tissuecontact surfaces 2108 a and 2108 b by the uterine wall, and thus therelative amount of contractility of the uterine wall. Thus, in someembodiments, the separation distance of middle portion 2104 (and/oftissue contact surfaces 2108 a, 2108 b) may be used as a measurement ofuterine contractility. This is described further with reference to FIGS.4A and 4B.

Elongate member 2102 may be made of any suitable shape memory material,such as but not limited to Nitinol, other shape memory metal alloys orshape memory polymers. Tissue contact surfaces 2108 a, 2108 b may bemade of the same material or a different material as elongate member2102. Typically, tissue contact surfaces 2108 a, 2108 b will be made ofa material that resists slipping on the intrauterine wall but that alsoresists tissue ingrowth, as described previously. In some embodiments,tissue contact surfaces 2108 a, 2108 b may comprise balls of formedmaterial, such as a polymer, deposited on the ends of elongate member2102. In other embodiments, such as the one in FIG. 3, tissue contactsurfaces 2108 a, 2108 b are simply portions of elongate member 2102.Generally, the term “end points” or “tissue contact members” or “tissuecontact surfaces” or other similar terms are used herein to refer toportions of an IUD that contact the uterine wall when the IUD is inplace. In many embodiments, the “tissue contact members” are at the endsof an elongate member and are the primary contact points of the IUD withthe uterus. In some embodiments, however, such as the embodiment justdescribed, IUD 2100 may include additional tissue contact surfaces orportions (for example expandable middle portion 2104), as will bedescribed further below. Whether the term used in relation to aparticular embodiment is “end points” or “tissue contact members” or“tissue contact surfaces” or some other similar term should not beinterpreted to limit the scope of the invention as it is defined by theclaims.

Forming tissue contact surfaces 2108 a, 2108 b as loops of elongatemember 2102, as in the embodiment shown in FIG. 3, may be advantageousfor a number of reasons. One reason is that such a configuration willallow IUD 2100 to be collapsed down to a very small cross-sectionaldiameter for insertion into a delivery device, because the loops ofelongate member 2102 can easily overlap. In some embodiments, forexample, contraceptive device 2100 may be compressible/collapsible to adiameter that fits within a delivery sheath having an inner diameter ofbetween about 2.50 mm and about 3.00 mm and more preferably betweenabout 2.70 mm and about 2.90 mm, and an outer diameter of between about2.80 mm and about 3.40 mm and more preferably between about 2.95 mm andabout 3.20 mm.

Referring now to FIGS. 4A and 4B, contraceptive device 2100 is shownimmediately after being delivered into a uterus (FIG. 4A) and afterslight migration down the uterine wall (FIG. 4B). In FIG. 4A, device2100 has been delivered, and tissue contact surfaces 2108 a, 2108 b arecontacting the inner uterine wall U near but not within the fallopiantubes. In this position, tissue contact surfaces 2108 a, 2108 b applypressure to the uterine wall U and are in an optimal position to preventconception. In most cases, IUD 2100 will remain in this position or veryclose to it, due to the slip resistant nature of tissue contact surfaces2108 a, 2108 b. In many cases, in fact, IUD 2100 may be deliveredinferiorly and migrate superiorly, sometimes contacting the fundus ofthe uterus U, as will be described in further detail below. In somecases, however, and with reference now to FIG. 4B, contraceptive device2100 may be subject to contractile pressures of the uterus which maycause the device to slide (or “migrate”) down the uterine wall U whileremaining within the uterine cavity. Significant migration of anyintrauterine device or ultimate expulsion of the device out of theuterus is obviously not desirable. Therefore, device 2100 is configuredsuch that when end points 2108 a, 2108 b are forced closer together,middle portion 2104 expands or bows outward to contact the uterine wallU along secondary contact surfaces 2112. Secondary contact surfaces 2112are simply lengths of middle portion 2104 that may contact the uterinewall upon expansion of middle portion 2104. Secondary contact surfaces2112 and end points 2108 a, 2108 b thus act together to contact theuterine wall U and prevent inferior migration (or further inferiormigration) of contraceptive device 2100. In this way, contraceptivedevice 2100 is configured to prevent its own inferior migration and/orexpulsion out of the uterus.

Additionally, the amount of separation distance of secondary contactsurfaces 2112 of middle portion 2104 is directly proportional to theamount of compression of end points 2108 a and 2108 b, and thusproportional to a relative amount of uterine wall contractility. Thisseparation or expansion of middle portion 2104 may thus be used as ameasurement tool for measuring approximate contractility of a uterus. Inone embodiment, middle portion 2104 (or part of middle portion 2104) maybe marked with one or more radiopaque markers or may be made radiopaque,to enhance visualization and thus facilitate measurement of uterinecontractility. In other embodiments, end points 2108 a, 2108 b may haveenhanced radiopacity for the same purpose. In still other embodiments,both middle portion 2104 and end points 2008 a, 2008 b may be maderadiopaque or include radiopaque markers. A method may includevisualizing the separation of middle portion 2104 and approximating anamount of uterine contractility from the separation.

The IUD embodiments described above provide effective contraceptionwithout the use of copper, Levonogestrel, other hormones or other drugsor substances. This may be advantageous in many circumstances, becauseany side effects potentially caused by such substances will be avoidedby using a “substance-free” IUD. In some embodiments, however, it may beequally or even more advantageous to provide an IUD that deliverscopper, hormone and/or one or more other substances in a limited dose tothe uterus. For example, a focal substance delivery IUD according to oneembodiment may deliver copper to a targeted area at or near each of theopenings of the fallopian tubes and/or at or near a cervical os.Although some amount of copper will typically permeate most or all ofthe rest of the interior of the uterus, it may remain concentrated inthe targeted areas of focal delivery. Thus, a lower dose of substancemay be delivered while still providing effective contraception, sincethe delivery is targeted toward areas of enhanced contraceptiveefficacy. In this way, a focal substance delivery IUD may providecontraception that is equal to or better than currently availabledevices while reducing or eliminating the side effects typically causedby such devices.

The IUD embodiments described below employ shape memory material tomaintain contact with a uterine wall and also provide selective deliveryof copper to targeted areas within the uterus. In alternativeembodiments, any of the IUDs described above may be altered to includedelivery of copper and/or one or more alternative substances. In someembodiments, an IUD may provide selective or targeted delivery of copperand application of uterine wall pressure to provide contraception. Thedelivery of lower dose copper or other substances described below may begenerally referred to as “selective,” “targeted,” “focal,” “localized”or the like. These terms generally mean that a substance is purposelydelivered to one or more areas within the uterus in a greaterconcentration than it is delivered to other parts of the uterus. Insummary, the IUDs described herein may provide contraception by theapplication of pressure, by targeted delivery of copper or othersubstance, or by both. Therefore, although a number of IUD embodimentsare described herein as having a particular mechanism of contraceptiveaction, in alternative embodiments they may be modified to haveadditional or other mechanisms also described herein.

Referring now to FIG. 5, in another embodiment, a contraceptive device(or “IUD”) 2200 similar to the one shown in FIG. 3 may include anelongate shape memory member 2202 having two tissue contact surfaces (or“end points”) 2208 a, 2208 b. Elongate member 2202 may have atwo-dimensional (i.e., predominantly flat) configuration, as shown, oralternatively may have a more three dimensional (i.e., slightly bent outof plane) configuration, as discussed above. Elongate member 2202 mayinclude a middle portion 2204, a spring portion 2206, and bends 2210between the middle portion 2204 and the tissue contact surfaces 2208 a,2208 b. Spring portion 2206 is generally located at an approximatemidpoint of the length of elongate member 2202—i.e., at the bottom ofIUD 2200. Middle portion 2204 is capable of expanding to contact theuterine wall and limit inferior migration and expulsion, as describedpreviously.

In this embodiment, four focal substance delivery members in the form ofcopper sleeves 2212 are disposed over elongate member 2202 close totissue contact surfaces 2208 a, 2208 b. Copper sleeves 2212 may delivera small amount of copper to the uterine wall near one of the ideallocations for contraceptive effect—i.e., near and just below thefallopian tubes. By providing focal delivery of copper, contraceptivedevice 2200 may provide the beneficial contraceptive effect of copperwithout the side effects often seen with currently available copperIUDs—i.e., excessive and/or non-menstrual bleeding. Such focal deliverymay also be described as “concentrated,” “selective,” “localized,”“targeted” or the like, as mentioned above. Copper sleeves 2212generally cover only a minority of elongate member 2202, and focaldelivery of copper thus achieves the desired contraceptive effect whiledelivering a lower overall dose of copper to the uterus, compared withcurrently available IUDs. For example, copper sleeves 2212 ofcontraceptive device 2200 may have an exposed surface area of no morethan about 200 square millimeters, and more ideally no more than about150 square millimeters, and even more ideally no more than about 125square millimeters. In the embodiment shown in FIG. 5, for example, thecopper sleeves 2212 have a surface area of about 125 square millimeters.By comparison, currently available IUDs typically have coppermeasurements of about 380 square millimeters—i.e., over three times asmuch as the surface area of copper sleeves 2212. By delivering copperlocally, near an ideal location within the uterus, contraceptive device2200 may accomplish the objective of copper without as many bleedingside effects.

In an alternative embodiment, copper may also be attached tocontraceptive device 2200 at or near spring portion 2206. Such coppermay be attached, for example, in the form of one or more sleeves or oneor more wires wrapped around elongate member 2202. Copper located inthis area on contraceptive device 2200 may be advantageous, because whencontraceptive device 2200 is implanted, that portion of the copper willbe located near to the cervical os (the opening of the cervix into theuterus). Copper disposed in this area will help stop sperm fromproceeding farther into the uterus. In another alternative embodiment(not shown), copper may be included at or near spring portion 2206 andnot near end points 2208 a, 2208 b. In alternative embodiments, sleeves2212 may be replaced by any other suitable substance delivery device(s),such as but not limited to copper wire(s), drug delivery depot(s), drugcoatings, drug eluting carriers, or the like.

In yet other alternative embodiments (also not shown), copper sleeves2212 may be used along with one or more hormone delivery devices, whichmay contain or be coated or impregnated with Levonorgestrel or any othersuitable hormone, which may be released over time into the uterus. Whena combination of copper and hormone is used, it may be possible to lowerthe doses of both the copper and the hormone to very low levels whilestill providing the desired contraceptive effect. In variousembodiments, any suitable hormone delivery device (or devices) may beattached to elongate member 2202, as desired.

Referring now to FIGS. 6A and 6B, another alternative embodiment of afocal substance delivery contraceptive device (or “IUD”) 2300 is shown,in front and perspective views, respectively. In this embodiment, IUD2300 may again include an elongate shape memory member 2302 having twotissue contact surfaces (or “end points”) 2308 a, 2308 b. Elongatemember 2302 may have a two-dimensional (i.e., predominantly flat)configuration, as shown, or alternatively may have a more threedimensional (i.e., slightly bent out of plane) configuration. Elongatemember 2302 may include a middle portion 2304, a spring portion 2306,and bends 2310 between middle portion 2304 and tissue contact surfaces2308 a, 2308 b. Again, spring portion 2306 is generally located at anapproximate midpoint of the length of elongate member 2302—i.e., at thebottom of IUD 2300. Attached to spring portion 2306 is a retrievalstring 2305, which may be a suture material or the like for retrievingthe device 2300 from the uterus.

This embodiment includes copper sleeves 2312 near each of tissue contactsurfaces 2308 a, 2308 b and additional copper sleeves 2314 near springportion 2306. Thus, the IUD 2300 may provide focal delivery of copper toareas of the uterus at or near openings of the fallopian tubes as wellas at or near the cervical os. In one embodiment, the total surface areaof copper sleeves 2312, 2314 may be no more than about 200 squaremillimeters and even more ideally no more than about 150 squaremillimeters. This embodiment includes four substance delivery sleeves2312 near tissue contact surfaces 2308 a, 2308 b and two sleeves 2314near spring portion 2306. In alternative embodiments, any other suitablenumber of sleeves may be included, such as between 1 and 20 sleeves. Inother alternative embodiments, sleeves 2312, 2314 may be replaced withsome other form of substance delivery device or mechanism, such as butnot limited to wires, coatings, apertures in elongate member 2302 thatleak a substance, permeable materials, beads coated or impregnated witha substance, or the like. Additionally, in various embodiments, sleeves2312, 2314 may be either loosely or tightly affixed to elongate member2302, so that they may be free to move in some embodiments and may befixedly attached in others.

With reference now to FIGS. 7A and 7B, as described previously, thevarious embodiments of the IUD described herein are configured to resistand/or limit inferior migration and expulsion of the IUD from a uterus.Some or all of the embodiments may also have a tendency, due to theirconfiguration and shape memory material, to migrate superiorly within auterus (i.e., toward the top or “fundus” of the uterus). For example, asshown in FIG. 7A, the IUD 2300 may be delivered into a uterus U in arelatively inferior location (for example, just beyond the cervical osO). In this location, the device 2300 and its substance delivery membersmay be located relatively far from the openings of the fallopian tubesF. As shown in FIG. 7B, however, the device 2300 may tend to expand andmove superiorly up the uterus U to a position closer to the fallopiantube F openings. This second, migrated position may be more effectivefor contraception. However, in either location, the copper sleeves 2312,2314 are located near the openings of the fallopian tubes F and thecervical os O, thus providing focal substance delivery in those areas.Thus, the embodiments described herein may facilitate delivery of anIUD, because it is possible to simply place the device just within theuterus and allow it to migrate to a more desirable location within theuterus. This will likely be easier than trying to position a device inan ideal location during initial delivery, which may requirevisualization, increased manipulation and potentially discomfort to thepatient.

With reference now to FIGS. 8A and 8B, in some embodiments, IUD 2300 maybe delivered to (or may migrate to) a first, relatively superiorlocation in the uterus, as shown in FIG. 8A. At this location IUD 2300may assume is fully expanded (or nearly fully expanded) configuration.At some later point, IUD 2300 may migrate slightly inferiorly, as shownin FIG. 8B, thus causing copper sleeves 2312 (or other substancedelivery devices) to move together to form a continuous lineapproximately horizontally across the uterus U. This approximatelyhorizontal line of copper sleeves 2312 may act as an approximatelyhorizontal, linear blockade to help block sperm from traveling throughthe uterus U toward the fallopian tubes F. At the same time, the othercopper sleeves 2314 are still located at or near the cervical os O tofurther enhance contraception.

Referring now to FIGS. 9A-9D, another alternative embodiment of a focalsubstance delivery contraceptive device (or “IUD”) 2500 is shown, infront, bottom, side and perspective views, respectively. In thisembodiment, IUD 2500 has all the features of the embodiment of FIGS. 6Aand 6B, but also includes additional copper sleeves. Thus, IUD 2500includes elongate shape memory member 2502 having two tissue contactsurfaces (or “end points”) 2508 a, 2508 b. Elongate member 2502 includesa middle portion 2504, a spring portion 2506, and bends between middleportion 2504 and tissue contact surfaces 2508 a, 2508 b. Again, springportion 2506 is generally located at an approximate midpoint of thelength of elongate member 2502—i.e., at the bottom of IUD 2500. Attachedto spring portion 2506 is a retrieval string 2505, which may be a suturematerial or the like for retrieving the device 2500 from the uterus.

In the embodiment shown, IUD 2500 includes copper sleeves 2512 near eachof the tissue contact surfaces 2508 a, 2508 b and additional coppersleeves 2514 near spring portion 2506, as in FIGS. 6A and 6B. In thisembodiment, however, there are four additional copper sleeves 2514 nearspring portion 2506, rather than two. Additionally, there are two addedcopper sleeves 2513, positioned on the loop formed at the opposite endsof elongate member 2502. Thus, the IUD 2500 may provide focal deliveryof copper to areas of the uterus at or near openings of the fallopiantubes as well as at or near the cervical os via a total of ten coppersleeves 2512, 2513, 2514. In one embodiment, the total exposed surfacearea of the copper sleeves 2512, 2513, 2514 may be no more than about200 square millimeters and even more ideally no more than about 150square millimeters.

With reference now to FIG. 10, another alternative embodiment of a focalsubstance delivery contraceptive device (or “IUD”) 2600 similar to theone shown in FIGS. 6A and 6B, and also including some of the extracopper sleeves of FIGS. 9A-9D is illustrated. This embodiment mayinclude an elongate shape memory member 2602 having two tissue contactsurfaces (or “end points”) 2608 a, 2608 b. Elongate member 2602 may havea two-dimensional (i.e., predominantly flat) configuration, as shown, ormay have a more three dimensional (i.e., slightly bent out of plane)configuration. Elongate member 2602 may include a middle portion 2604, aloop portion 2606 disposed at the vertex (or bottom) of elongate member2602, and bends 2610 between middle portion 2604 and tissue contactsurfaces 2608 a, 2608 b. Attached to loop portion 2606 is a retrievalstring 2605, which may be a suture material or the like for retrievingthe device 2600 from the uterus. The device 2600 includes copper sleeves2612 near each of the tissue contact surfaces 2608 a, 2608 b andadditional copper sleeves 2614 near loop portion 2606, as described withrespect to the device 2300 depicted in FIGS. 6A and 6B.

In this embodiment, the bottom loop portion does not form any turns of aspring structure. Instead, to generate the resilience in the arms of thedevice as in the other embodiments described herein, this embodimentincludes twists 2616 along the middle portion 2604 of the arms as theyextend from the tissue contact surfaces toward the loop portion 2606.Twists may be formed when the two arms of the elongate member 2602 crosseach other more than once in a longitudinally extending helix containingmultiple turns that run in series from closer to the loop portion 2606outward along the arms until the arms diverge again from the twistedportion to form the opposing ends of the elongate member. FIG. 10 showsthree twists 2616. However, other numbers of twists (e.g., 1-5, 6-10,greater than 10) are also possible. In this embodiment, the twists 2616act as the “spring portion” to confer laterally directed pressure totissue contact surfaces 2608 a, 2608 b.

It may be desirable to be able to easily modify the properties of theelongate member 2602. For example, the anatomical dimensions orcharacteristics of the uterus or medical conditions of a patient maycall for adjustments to the outward force produced by the device 2600.In such applications, the location of the twists along the middleportion 2604, the number of the twists 2616, and the tightness of thetwists 2616 may be used to provide variability in the properties of thedevice 2600. For example, increasing the number of twists 2616 mayincrease the stiffness of the elongate member 2602; and decreasing thenumber of twists 2616 may decrease the stiffness of the elongate member2602. For another example, increasing the tightness of the twists 2616may increase the stiffness of the elongate member 2602. Decreasing thetightness of the twists 2616 may decrease the stiffness of the elongatemember 2602. Moving the twists 2616 up along the middle portion 2604 mayincrease the stiffness of the elongate member 2602; and moving thetwists down along the middle portion 2604 may decrease the stiffness ofthe elongate member 2602. With the device of FIG. 10, a variety ofdifferently configured devices can be made available to physicians toapply in the appropriate circumstances. The variability provided by thetwists also allows much easier and more continuous customization ofproperties by merely modifying the nature of the twists, rather than thethickness or material of the wire itself to produce similar variationsin properties. Wires come in standard sizes and materials, and if someintermediate is desired, the expense can make producing such a modifieddevice impractical. Controlling properties of the device with theproperties of the twists 2616 resolves this issue.

Referring now to FIG. 11, as mentioned above, one drawback with currentIUDs is that delivery of the IUD through the cervix into the uterus canbe uncomfortable or even painful. Additionally, currently available IUDstypically require a physician or assistant to load the IUD into thedelivery device in the clinic, because preloading the IUD will typicaldeform the material it is made of and thus adversely affect its abilityto stay in the uterus. In one embodiment, an IUD delivery device 2400may be configured to address at least some of these drawbacks. Deliverydevice 2400 may include a tubular shaft 2402 (or “sheath”), a tapereddistal tip 2404, a pusher member 2410 disposed at least partially withinshaft 2402, and a handle 2406. A retrieval string 2405, which is part ofthe IUD, may extend out the proximal end of the delivery device 2400.

Delivery device 2400 and its combination with the IUD embodimentsdescribed above may have a number of advantages over currently availabledevices. First, the shape memory IUDs described herein may typically bepreloaded into shaft 2402 without causing permanent deformation of theIUDs. This enhances ease of use, since currently available devicestypically must be loaded by the physician. Second, the IUDs describedherein may be preloaded by advancing the IUD into a proximal end ofdelivery device 2400, rather than by pulling the IUD into the distal endof a delivery device, as currently available devices work. Sincedelivery device 2400 is preloaded proximally, it may include tapereddistal tip 2404, which will likely be more comfortable when advancedthrough the cervix. In contrast, when the physician has to load the IUDby pulling it into the distal end of a delivery device in the clinic,such a tapered distal tip 2404 is not feasible.

The outer diameter of the shaft 2402 may be made smaller than currentlyavailable devices, because the shape memory IUDs described above aregenerally collapsible to fit in a smaller inner diameter. In someembodiments, for example, an IUD such as those described above may becollapsible to a diameter that permits shaft 2402 to have an outerdiameter of between about 2.80 mm and about 3.40 mm, and more preferablybetween about 2.95 mm and about 3.20 mm. Fourth, although not visible inFIG. 11, an inner wall of the shaft 2402 may have slots forguiding/orienting an IUD within the delivery device 2400. Such slots mayhelp with delivery of the IUD, because the physician will know, based onthe position of the delivery device 2400 relative to the patient, whatthe orientation of the IUD is. Again, this is not a feature of currentlyavailable IUD delivery devices, and such guiding/orienting with slotswould not generally be possible when the physician must load the IUDinto the delivery device in the clinic. In some embodiments, the pushermember 2410 may also have one or more guiding/orienting features, suchas protrusions to fit within the slots of the inner wall of the shaft2402. In some embodiments, one or more markings may also be included onthe shaft 2402, pusher member 2410 and/or handle 2406 for helpingguide/orient an IUD for facilitating delivery.

Various embodiments of a contraceptive intrauterine device and methodsfor using it have been disclosed above. These various embodiments may beused alone or in combination, and various changes to individual featuresof the embodiments may be altered, without departing from the scope ofthe invention. For example, the order of various method steps may insome instances be changed, and/or one or more optional features may beadded to or eliminated from a described device. Therefore, thedescription of the embodiments provided above should not be interpretedas unduly limiting the scope of the invention as it is set forth in theclaims.

Although this invention has been disclosed in the context of certainpreferred embodiments and examples, it will be understood by thoseskilled in the art that the present invention extends beyond thespecifically disclosed embodiments to other alternative embodimentsand/or uses of the invention and obvious modifications and equivalentsthereof. Thus, it is intended that the scope of the present inventionherein disclosed should not be limited by the particular disclosedembodiments described above, but should be determined only by a fairreading of the claims that follow.

What is claimed is:
 1. A contraceptive device for localized delivery ofa substance in a uterus, the contraceptive device comprising: only oneelongate shape memory member, comprising: a bottom loop disposed at abottom of the contraceptive device; a middle portion extending upwardfrom the bottom loop, the middle portion comprising a first part of theelongate member and a second part of the elongate member; at least onetwist configured to act as a spring portion; a first arm extending fromthe first part of the middle portion, wherein the first arm comprises afirst bend in a first lateral direction away from the middle portion; asecond arm extending from the second part of the middle portion, whereinthe second arm comprises a second bend in a second lateral directionaway from the middle portion, and wherein the first arm and the secondarm cross over one another at a location along the first bend and thesecond bend, above the at least one twist; a first tissue contactsurface at a first end of the first arm; and a second tissue contactsurface at a second end of the second arm; at least a first substancedelivery sleeve coupled with the first arm at or near the first tissuecontact surface; at least a second substance delivery sleeve coupledwith the second arm at or near the second tissue contact surface; and atleast a third substance delivery sleeve coupled with at least one of thebottom loop or the middle portion near the bottom loop, wherein thefirst, second and third substance delivery members are positioned on theelongate shape memory member at locations configured to locally deliverthe substance to the uterus in an area near the fallopian tubes and anarea near a cervical os.
 2. The device of claim 1, wherein the at leastone twist comprises three or more twists.
 3. The device of claim 1,wherein the substance is selected from the group consisting of copperand other spermicidal agents.
 4. The device of claim 1, wherein thesubstance comprises copper, and wherein the substance delivery sleeveshave a total surface area of no more than about 200 square millimeters.5. The device of claim 1, wherein the substance comprises copper, andwherein the device further comprises a hormone delivery member coupledwith the elongate member.
 6. The device of claim 1, wherein thesubstance comprises a hormone.
 7. The device of claim 1, wherein the atleast the first substance delivery sleeve comprises multiple sleeves,wherein the at least the second substance delivery sleeve comprisesmultiple sleeves, and wherein the at least the third substance deliverysleeve comprises multiple sleeves.
 8. The device of claim 1, wherein thefirst end of the elongate shape memory member comprises a first loop,and wherein the second end of the elongate shape memory member comprisesa second loop.
 9. The device of claim 8, wherein at least one of the atleast the first substance delivery sleeve is disposed on the first loop,and wherein at least one of the at least the second substance deliverysleeve is disposed on the second loop.
 10. The device of claim 1,wherein the at least the third substance delivery sleeve comprisesmultiple sleeves, and wherein at least one of the multiple sleeves iscoupled with each of the first part and the second part of the middleportion.
 11. The device of claim 1, wherein the at least the thirdsubstance delivery sleeve comprises multiple sleeves coupled with thebottom loop.